Provider Demographics
NPI:1033165642
Name:SHINGLEDECKER, LEON G (DPM)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:G
Last Name:SHINGLEDECKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 HINSON FARM RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3403
Mailing Address - Country:US
Mailing Address - Phone:703-765-4321
Mailing Address - Fax:
Practice Address - Street 1:8101 HINSON FARM RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3403
Practice Address - Country:US
Practice Address - Phone:703-765-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001046213ES0103X
PASC002084L213ES0103X
LA200007213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9300619Medicaid
VA9300619Medicaid